Provider Demographics
NPI:1639125214
Name:BEN DOMIANO OPTICAL INCORPORATED
Entity Type:Organization
Organization Name:BEN DOMIANO OPTICAL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:DOMIANO
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC OPTICIAN
Authorized Official - Phone:570-457-2020
Mailing Address - Street 1:817 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1431
Mailing Address - Country:US
Mailing Address - Phone:570-457-2020
Mailing Address - Fax:570-457-2787
Practice Address - Street 1:817 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1431
Practice Address - Country:US
Practice Address - Phone:570-457-2020
Practice Address - Fax:570-457-2787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPA817OtherVISION BENEFITS OF AMERIC
PA48926OtherGEISINGER
MD15932OtherSPECTARA
NY9911OtherDAVIS VISION
PADO0001565000OtherHIGHMARK
PABE282600OtherCLARITY VISION
OHPA0685OtherEYEMED/COLE VISION
NJ393342OtherNVA
NJ393342OtherNVA
PA48926OtherGEISINGER